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Carpal tunnel syndrome in manual wheelchair users with spinal cord injury: A cross-sectional multicenter study

Yang, J and Boninger, ML and Leath, JD and Fitzgerald, SG and Dyson-Hudson, TA and Chang, MW (2009) Carpal tunnel syndrome in manual wheelchair users with spinal cord injury: A cross-sectional multicenter study. American Journal of Physical Medicine and Rehabilitation, 88 (12). 1007 - 1016. ISSN 0894-9115

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Objective: To investigate relationships between carpal tunnel syndrome, functional status, subject demographics, physical examination findings, and median nerve conduction study findings in manual wheelchair users with paraplegia. Design: Multicenter cross-sectional study. One hundred twenty-six manual wheelchair-using individuals with chronic paraplegia answered self-administered questionnaires on demographics, symptoms, and functional status. They underwent physical examination specific for carpal tunnel syndrome and upper-limb nerve conduction studies. Results: Fifty-seven percent of subjects had symptoms (72.2% bilateral); hand numbness was most common. Sixty percent of subjects had carpal tunnel syndrome physical examination findings (59.2% bilateral). Those with physical examination findings were more likely to have longer duration of injury (P = 0.003). Seventy-eight percent of subjects had electrophysiologic evidence of median mononeuropathy. Symptomatic subjects had significantly greater median-ulnar motor latency difference in the dominant hand (P = 0.02) and smaller compound muscle action potential amplitudes bilaterally (dominant hand, P = 0.01; nondominant hand, P = 0.04). Persons with carpal tunnel syndrome symptoms and physical examination findings had significantly worse functional status (symptoms, P < 0.001; physical examination, P = 0.02) and symptom severity scores (symptoms, P < 0.001; physical examination, P = 0.01), but a similar difference between subjects with and without median mononeuropathy was not seen. Logistic regression analysis revealed that the presence of symptoms was predicted by median-ulnar motor latency difference in the dominant hand (odds ratio, 4.38; 95% confidence interval 1.72-11.14) and sensory nerve action potential amplitude in the nondominant hand (odds ratio, 0.97; 95% confidence interval, 0.94-0.99). ConclusionS: The interaction among symptoms, physical examination, and nerve conduction study findings is complex. Carpal tunnel syndrome and median mononeuropathy are highly prevalent and functionally significant. This study highlights the need for primary prevention and patient education for preserving upper-limb function. Copyright © 2009 by Lippincott Williams & Wilkins.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Yang, J
Boninger, MLboninger@pitt.eduBONINGER
Leath, JD
Fitzgerald, SG
Dyson-Hudson, TA
Chang, MW
Centers: Other Centers, Institutes, Offices, or Units > Human Engineering Research Laboratories
Date: 1 December 2009
Date Type: Publication
Journal or Publication Title: American Journal of Physical Medicine and Rehabilitation
Volume: 88
Number: 12
Page Range: 1007 - 1016
DOI or Unique Handle: 10.1097/phm.0b013e3181bbddc9
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science and Technology
Refereed: Yes
ISSN: 0894-9115
MeSH Headings: Adult; Age Factors; Aged; Body Mass Index; Carpal Tunnel Syndrome--diagnosis; Carpal Tunnel Syndrome--etiology; Cross-Sectional Studies; Electromyography; Female; Humans; Male; Middle Aged; Odds Ratio; Paraplegia; Risk Factors; Severity of Illness Index; Sex Factors; Spinal Cord Injuries--rehabilitation; Wheelchairs--adverse effects; Young Adult
PubMed ID: 19789435
Date Deposited: 18 Oct 2012 19:22
Last Modified: 05 Feb 2019 03:55


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